The International Workforce Well-Being · The International Workforce Well-Being Survey 2019. This...

The International Workforce Well-Being Survey 2019

46.05.111.1

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This 2,000-respondent survey shows the impact of various factors of international relocation on health and well-being – from work life and wages to settling children and the perceived threat of civil unrest.


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Contents 4 Relocating abroad and its impact on health and well-being

5 Study summary: headlines, key findings and summary

The positiveThe negativeThe greatest challenges to settling inAdapting to a new lifeOtherfindings

8 The challenges of moving abroad

9 Impact of challenges on well-being

10 Impact on well-being

11 Impact of work on well-being

12 Expat first experiences

14 Barriers to settling in

15 Perceived attitudes of the host country towards expats

17 Security and civil unrest

19 The influence of health and health care: Fitness

20 Wearables

21 Virtual health care

22 Health insurance

25 Appendix

Further readingMethodologyKeyprofilingcharacteristics


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Relocating abroad and its impact on health and well-being

There are 50.5 million expats around the world. For these individuals, succeeding in a newroleorfindingwork,stayinghealthyandsettlingfamiliesintolifeindifferentcultures

can all have an impact on the happiness and well-being of everyone involved.

It is good news for everyone – including expats – that health care is being reimagined. Today, it’s far more personal and focused on preventing people from developing conditions or diseases, as well as supporting them if they do fall ill.

It has also become widely understood that everyone has their own set of personal circumstances, health history and goals. Often referred to as ‘social determinants of

health’, these circumstances include a range of factors, from whether we smoke and exercise to our education and the impact of air, noise and water pollution in our environment. Expats have their own set of social determinants and health pressures due to their specificsituation–leavingtheirhomecountryandrelocating abroad.

We believe that by understanding the people we serve and helping them become healthy, happy individuals, with healthy, happy families, we can help them live successful new lives overseas.

This survey aims to discover the impact of moving abroad – especially for work – and the variables that caninfluenceanindividual’shealthandwell-being.

Thedataoffersnewandvaluabledetailonthelifeof2,000 working-age expats from a range of nationalities livingin10differentcountries,includingCanada,HongKong,Singapore,theUKandUAE.Seventy-fivepercentof respondents are full-time employees, with two thirds basedinanoffice.Therespondentshadallbeenlivingabroadfornomorethanfiveyears.

https://paragonrelocation.com/new-report-shows-record-number-of-expats-worldwide/


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Study results: headlines, key learnings and summary

Living abroad and the impact on well-beingThe data reveals that, from our list of choices (including theinfluenceofaccesstoasocialsupportnetwork,good education options for children, and corporate well-being programmes), moving abroad impacts well-being more positively than it does negatively.

The positiveHealth careThirty-two percent of expats said that the quality of the health care system in their new home had a positive impact on their well-being and 82% had made their firsttriptothedoctorwithinthefirstsixmonths; women being far more likely to gosooner(42%wentinthefirstmonthcompared to 29% of men). Despite this, women are less likely to have private medical insurance to cover them once they move – 48% vs 60% of men. This could be, at least in part, a product of the higher number of men in work and covered by a group scheme.

Attitudes to technology as a route to well-being Expats are positive about innovation and technology. They have Fitbits and other wearables that they want to use to improve their health. They also embrace the idea of virtual health which can help people access primary care wherever they are, whenever they need.


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The negative The world of work Job-related factors are among the least challenging aspects of moving, but their impact is more negative than positive on individuals’ well-being, with wage levels beingtheonlysignificantpositiveimpacton overall well-being within the workplace. It appears that other aspects get worse by working abroad – from corporate culture toattitudesaboutflexibleworking.Withinthis, men are more likely to say that challenges relating to settling into a new job have a negative impact on their well-being - 88% vs 75% of women. This is also reflectedinthefindingthat33%ofmenand 26% of women said work/life balance in their new country had a negative impact on their well-being. The suggestion is that improved wages come at the cost ofwork/lifebalance.However,womenaresignificantlymorelikelytosaythatmovingabroad has had a positive impact on their home life – 32% vs 23% of males.

The greatest challenges to settling inSettling childrenThis is the biggest challenge. It is important to note that women are significantlymorelikelytofeelanegativeimpact from the challenge of settling the children (88% vs 66% of men) and making new friends (48% vs 40%).

The local languageThe inability to speak the local language is also very challenging but does not impact expatwell-beingtoanysignificantextent.


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Adapting to a new lifeSettling in is a complex process made up of several factors, from making friends to eating localfood.Mostexpat‘firstexperiences’happenwithinthefirstsixmonths.Forunmarried, single people, dating is the most challenging aspect of moving abroad with 76% ofsingleexpatsfindingithard.Thisisalsosupported by the fact that it remains the event that takes the longest to happen from our list of options that include: a trip to the doctor and conversational use of the local language.

The role of genderGender is the biggest barrier to settling in mainly felt by women (25% vs 5% of men). Religion is the least frequently cited barrier from our list. It may be unsurprising that the more visible aspects (gender, ethnicity) are the biggest barriers, while ‘invisible’ factors (sexual orientation, marital status) are the least. In a time when the news feels filledwithreportsofreligioustensions,98% people living away from home feel no

religious discrimination. Only 2% said that their religion has been a barrier but there are some notable deviations from the survey average within countries. These can be found in our country breakdowns at the end of this document.

Other findingsPerceived local attitudes to expatsThose living abroad see attitudes towards expats as remaining positive (80%) while there is near parity between the perceived views of expats getting better and worse (4% and 5% respectively). There are some interesting deviations from this, for example, attitudes to expats in the UK, Thailand and Indonesia are getting worse at almost twice the rate as those in other nations featured in the survey.

Security and safety18% of expats are worried about the threat to their personal safety from war, civil unrest and political upheaval. For some it has a negative impact on their well-being.


The challenges of moving abroad

Question: Howhaveyoufeltabouteachofthe following aspects of moving and living abroad, since you made the move? Please rate on the following scale from 1 to 4 where: 1 = Very challenging 2 = Quite challenging 3 = Quite easy 4 = Very easy

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% of respondents answering 1-2

Percentage of respondents answering 1-2

* Only asked of those who were single

† Only asked of those with children living at home

Key findings

1 Dating is the most challenging aspect of moving abroad for 76% of single expats – especially for men

2 Establishing a support network (new friends, findingacommunity)isabiggerchallengethanculture (new language, new ways of working)

3 Job-related factors are among the least challenging aspects of moving we asked about.

% Single (country of origin) % Single (country of residence)


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Impact of challenges on well-being

Question: For each of those aspects that you have found challenging, can you say to what extent this has impacted your sense of well-being. Please rate on a scale from 1 to 3 where:1=Significantnegativeimpact2 = Limited negative impact 3 = No negative impact

* Only asked of those who were single

† Only asked of those with children living at home

Key findings

1 Of the challenges listed, the following had the biggest negative impact on well-beinga. Settling childrenb. New ways of workingc. New job

2 A new language is a challenge, but doesn’t impact well-being

3 Finding a community also doesn’t significantlyimpactwell-being.

No impact

Limited impact

SignificantImpact


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Impact on well-being

Question: Howwouldyouratetheimpactofthefollowing things on your wellness and general health while living in [country]?

Key findings

1 Most people said the aspects of life presented (including work life and home life) had not impacted their well-being since relocating abroad

2 Of the factors tested fortheirinfluenceonwell-being, more of the factors are positively impacted by moving and living abroad

3 The biggest negative impact on well-being experienced by expats related to work life where 21% said it had a negative impact

4 Climatewasreportedas having the second greatest negative impact with 18% suggesting their well-being was affected

5 Education for children had the biggest positive impact on well-being (39%)

6 Healthcarehadthesecond biggest positive impact on well-being (32%).

Made it worse

Made it better


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Impact of work on well-being

Question: Havingmovedto[country],howhasyouroverallwell-being been impacted by each of the following factors related to your working life?

Key findings

1 69-89% of respondents said that the work-related environment had no impact on well-being

2 The three factors with fewerpeoplefindingthem challenging had the most saying that it had a health impact. There is a sense that issues such as starting a new job or settling children are fineiftheygowellbutpotentiallydifficultandunsettling if not

3 Wages have the biggest positive impact on well-being (28%)

4 While wage levels have asignificantpositiveimpact on well-being (28%), other aspects are more detrimental. For example, 21% of respondents said corporate culture has reduced their well-being

5 The most negative things were corporate culture (21%) and working practices (13%)

6 The negative impact of corporate culture on well-being is seven times that of the positive impact.

Reduced well-being No impact Improved well-being

Wage level impact for those glad they moved

33%

66%

1%

Wage level impact for those who wished they had stayed at home

20% 14%

66%

Corporatecultureimpactfor those not glad they moved

77%

19%4%

Corporatecultureimpactforthose glad they moved

63%

33%

4%


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Expat first experiences

Question: Thinking now about each of the following, how long did it take to reach each ‘milestone’, after your move abroad?

Key findings

1 Mostexpat‘firsts’happenwithinthefirstsixmonths

2 82% of expats go to the doctor inthefirstsixmonthsofmovingabroad!

3 Expats report that they’ve found it easier to make expat friends, followed by making foreign friends, followed by a friend of the same nationality (these take longer to find).Itseemsmanypeoplewillnotmake a foreign friend

4 Women (42%) are 13 percentage points more likely to visit the doctor inthefirstmonththanmen(29%).

First… 1 Month 2 to 6 Months

7 to 12 Months

Over 12 Months

Foreign friend 24% 42% 4% 8%

Expat friend 27% 44% 2% 9%

Friend of same nationality 21% 49% 2% 9%

Conversational language use 41% 28% 2% 4%

Local dish (not from home) 28% 46% 2% 5%

Trip to the doctor 34% 48% 4% 5%

Foreign date (potential partner) 12% 28% 3% 5%

Felt part of local community 24% 41% 4% 9%


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Some of our respondents said: ‘Not happened yet’. This is the breakdown of how long these people have been expats.

% of audience saying “Not happened yet”

Length of time living in country

1-2 Years

2-5 Years

* Where dating, = single people.

Percentage of expats who moved to a given country where they speak the native language.

% speaking native language of country moved to

*


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Barriers to settling in

Question: Do you think that any of the following personalcharacteristicsandprofileshavebeen barriers to you settling in [country]?

Key findings

1 Not much discrimination is felt by expats, especially towards religion

2 Gender discrimination was felt by the highest number of expats with the gender split 25% of women vs 5% of men

3 Countrieswithlowerthanthesurveyaverage for barriers werea. Canada;b. Mexico; andc. Spain (except as for religion)

4 Countrieswithhigherthanthesurveyaverage for barriers werea. India;b. Thailand;c. The UAE; andd. The UK.

% of people who found a given factor a barrier


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Perceived attitudes of the host country towards expats

Question: Howwouldyourateattitudesandlevel of support for each of the following in [country]?

Key findings

1 Most expats either don’t have a particular view or don’t know what attitudes in their new home are

2 It’s perceived that host countries had positive attitudes to stayingfitandhealthy

3 It’s perceived that host countries had negative attitudes towardsflexibleworking,worklifebalance,equality,andmental health

4 Men’s health issues enjoy 22% positive attitudes whereas women’s health had only 17% positive responses.

Negative Positive


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Question: Since you’ve been living in [country], how do you feel attitudes to expats have changed there?

Impact on well-being of those aspects found challenging

Remain Good

Getting Better

Remain Bad

Getting Worse

Key findings

1 80% of expats feel attitudes to expats remain good

2 10% of expats wish they were at home

3 Only 9% of expats said attitudes are changing (getting better or getting worse).

Question: Which of the following bestdescribes how you feel about living in [country] at the moment?

70%

20%

10%


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Security and civil unrest

Question: Are you concerned about the threat of civil war, civil unrest or political upheavalwhere you are? And if so, does this impact your general health?

Key findings

1 82% of expats are not concerned about civil war, unrest or political upheaval

2 18% are worried about these threats, and, of this, 4% are very worried

3 Only 4.5% of the total quota have their health and well-being impacted by these threats (25% of 14%+4%)

4 ExpatsinHongKongarethemostconcerned about security issues

5 Expats in UAE are the least concerned about security issues

6 Of those who are glad they’re living abroad, only 14% are concerned about civil war, unrest or political either a lot or a little

7 Of those who wish they were living at home, 41% are concerned about civil war, unrest or political upheaval either a lot or a little

Concerned about civil war, unrest or political upheaval in...

82%

14%4%

If yes, does it impact health?

25%

75%


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Sense of civil unrest, political upheaval in country

Yes, a lot

Yes, a little

Not at all

Impact of civil unrest, political upheaval in country

Yes, a lot

Yes, a little

Not at all


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The influence of health and health care: Fitness

Question: Doyoumakeaconsciousefforttostayfitandhealthy?

32%

23%

27%

18% Key findings

1 55% of expats said they try and stay healthy

2 18% of expats makenoefforttostayfitandhealthyand are happy with that

3 82% of expats either feel they should make a consciousefforttostayfitandhealthy,ormakeaneffortat least some or most of the time.

Do you make a conscious effort to stay fit and healthy?

% yes (some or most of the time)


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Wearables

Question: Do you have a Fitbit or otherhealth/fitness-relatedwearable?If yes, has it been more or less useful away, than at home?And would you be prepared to share your data with an insurer and/or medical professionals to help improve your overall health and well-being?

Have/Use Fitbit or other wearables

60%

10%

30%

If yes, more or less useful away from home

55%

31%14%

Willing to share data with insurer and/or medical professionals?

Key findings

1 40% of expats have a wearable such as a Fitbit

2 Of these, 70% would be happy to use the data it gathers to help insurers and medical professionals

3 86% said they are the same or more useful having moved abroad.

30%12%

58%


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Virtual health care

Question: We are interested in your views on virtual health care. This can be definedasthedeliveryofprimarycare services through the use of technology, such as tablets or smartphones. It can help to maintain a patient’s health and well-being, provide consultations for acute illness and improve monitoring and management of chronicconditions.Howlikelywouldyou be to use a virtual health care service (such as telephone or online doctor consultations) to access health care on a scale of 1 to 10, where 1 - Not at all likely and 10 - extremely likely?

Likelihood of using virtual health care services1 = Not at all to 10 = Extremely Likely

5%

5%5%

21%

17%

15%

25%

3%2% 2%

Key findings

1 The majority of expats said they are likely or highly likely to use virtual health care services

2 Younger age groups (30-49) are more likely to use it than older ages groups (50+)

3 Those with children were more likely to use virtual health than those without.

Age groups most/least likely to adopt virtual health

Impact of parenthood on views of virtual health


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Health insurance

Question: Do you have private health insurance? If so, what type?Haveyoutravelledfortreatmentwhile living away from home?

Key findings

1 56% of expats have a private health insurance plan

a. Of them, 69% have insurance through work or as part of a family member’s plan

b. 21% pay for their own individual plan

2 21% of expats have travelled outside their host country for treatment

3 48% of women have health insurance, while 60% of men do.

Health insurance holding

56%44%

Type of health insurance

9%

21%

69%

Travelled for treatment while away?

79%

14%

7%


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Percentage with PMI by country of residence

UAE

HongKong

Singapore

Mexico

Indonesia

Canada

Thailand

India

Spain

UK

Percentage with PMI by country of origin (selected countries)


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Travel for treatment by country of residence

Travel for treatment by country of origin (selected countries)


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Appendix

Expat Family

01rvey 2Health & Wellness

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Su

Further readingFollow the links below to read more about the topics covered in this survey:

Employer’s Guide to International Assignment SuccessBringing virtual health care to life;Civilunrest:militarycoupevacuationcasestudy;Flying for treatment: an introduction to health care tourism;International child health for globally mobile families; Mental health support for expats.

Other Aetna International research includes:What Is Wellness Survey 2018; andExpat Experience Survey 2018.

MethodologyThis survey is formed of an online survey of 2,000 people living and working outside of their home country.

The survey took approximately 10 minutes to complete and covered a range of questions on health and well-being issues from home, work and personal life.

Surveyingwasconductedin10differentcountries(200individuals per country):

Canada;HongKong;India;Indonesia;Mexico;Singapore;Spain;Thailand;The UAE;The UK.

Respondents were drawn largely from major expat populationssuchasUS,India,UK,China,France,Australia– but with more than 60 home countries represented.

The quota includes a maximum 20% sample from any single country, in any one country.

Allrespondentswerewithinthefirstfiveyearsofhavingmoved, to avoid capturing the views of those who have effectivelysettledlong-termintheirnewcountry.

Quotas where set on factors such as presence of children, insurance holding, and age and gender.

ThefieldworkwasconductedinSeptember2018.

https://www.aetnainternational.com/en/about-us/explore/international-health-insurance/employee-guide-international-assignment-success.html

https://www.aetnainternational.com/en/about-us/explore/future-health/virtual-health-care.html

https://www.aetnainternational.com/en/about-us/explore/international-health-insurance/crisis-management-military-coup.html

https://www.aetnainternational.com/en/about-us/explore/health-care/prevent-manage-conditions/flying-for-treatment.html

https://www.aetnainternational.com/en/about-us/explore/health-care/prevent-manage-conditions/flying-for-treatment.html

https://www.aetnainternational.com/en/about-us/explore/health-care/lifestyle-better-health/international-child-health.html

https://www.aetnainternational.com/en/about-us/explore/health-care/lifestyle-better-health/mental-health-support-abroad.html

https://www.aetnainternational.com/en/about-us/explore/health-care/lifestyle-better-health/what-is-wellness-2018.html

https://www.aetnainternational.com/en/about-us/explore/living-abroad/expatriate-life/expat-survey.html


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Key profiling characteristicsThe lower age limit was set at 30 years old, with the largest proportion of respondents in the 30-39 bracket but includessignificantnumbersuptoage59.

Almost three-quarters are full-time employees, and more than two-thirds are office-based.Thus,thebasereflectsthemore typical ‘expat on assignment’.

All respondents had to be earning in the top 25% of incomes for the country they live in, to exclude lower income, transient migrant workers but incomes are then categorised into mid, mid/high and high income for the sample (based on local currency) – with nearly three-quarters in mid and just 7% in high.

Age

29%

45%

8%

15%

3% Employment

73%

17%

7%

Employment type

67%

18%

15%

Income

72%

21%

7%


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All had to have been no more than 5 years into their time away from home. Around1in3areintheirfirstyearoverseas.

We have more males in our sample than females but also include 10% who did not want to disclose gender.

40% of the sample were families, with children living at home.

Time away from home (Max 5 years)

8%

26%

43%

22%

Native speaker of host country language

84%

16%

Gender

40%

50%

10%

Children living at home

40%

60%

The information included in this communication is provided for information purposes only and it is not intended to constitute professionaladviceorreplaceconsultationwithaqualifiedmedicalpractitioner.Aetnadoesnotdiagnose,providecareorguarantee

access to health services. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions, and the terms and conditions of the relevant plan documents.NoticetoUKresidents:IntheUnitedKingdom,AetnaInsuranceCompanyLimited(FRN458505)

has issued and approved this communication. Notice to all: Please visit http://www.aetnainternational.com/ai/en/about-us/legal/regional-entities for more information, including a list

of relevant entities permitted to carry on or administer insurance business in their respective jurisdictions. Aetna®isatrademarkofAetnaInc.,aCVScompany,andisprotectedthroughouttheworldbytrademarkregistrationsandtreaties.

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